Managing Utilization

ABSTRACT

A computer-implemented method includes receiving a request from a consumer of medical services to engage with a provider of medical services in real time over the Internet using a computer-based brokerage system, accessing stored information related to past engagements of the consumer using the computer-based brokerage system, and determining allocation of a fee between the consumer and a third party for an engagement between the consumer and the provider based at least in part on the information related to the past engagements of the consumer.

CLAIM OF PRIORITY

This application is a continuation and claims priority under 35 U.S.C.§120 to U.S. patent application Ser. No. 12/059,292, filed on Mar. 31,2008, which in turn claims priority under 35 U.S.C. §119(e) toprovisional U.S. Patent Application 60/997,222, filed on Oct. 2, 2007,the entire contents of each of which are hereby incorporated byreference.

BACKGROUND

The present disclosure is directed to connecting consumers with serviceproviders.

Systems have been developed to connect consumers and their providersover the Internet and the World Wide Web. Some systems use e-mailmessaging and web-based forms to increase the level of connectivitybetween a member of a health plan and his assigned health care provider.The consumer sends an e-mail or goes to a website that generates andsends a message (typically an e-mail or an e-mail type message) to alocal provider.

These types of services have been broadly referred to as “e-visits.”While generally viewed as an addition to the spectrum of services thatmay be desired by consumers, the benefits of such services are notclear. One of the concerns associated with offering additionalcommunication channels, such as e-mail, is that it can result in overconsumption of services, rather than provide for better coordination.

Until recently, the notion of an electronic encounter was not even codedin the standard financial coding schemes used for submitting medicalclaims, preventing proper reimbursement of providers for suchencounters. This gap has been recently corrected by the introduction ofCPT (current procedural terminology) code 0074T, allowing providers tosubmit a reimbursement claim for an electronic encounter (e.g., e-visit)with their patients. Most plans at this time, however, do not includethis service code as a covered service (i.e., a benefit) making it anout-of-pocket expense for members and an unattractive offering forproviders (who need to charge members directly for such encounters).

Recently, a number of health plans announced their intention to beginremunerating providers for electronic visits (i.e., paying a certainconsideration for claims submitted with a CPT 0074T code). While limitedto pilot projects, plans are embracing the notion of consumerism byoffering advanced tools for consumers to become informed and acquiremedical services. Facilitating timely and more organized communicationbetween the member and their provider is perceived as a naturalinvestment in the new consumer-driven healthcare world. While still atan early stage, interest in e-visits has picked up both in thecommercial world as well as in the strategic planning sessions of healthplans around the country. Vendors offering health portals for healthplans typically now describe their roadmap for the incorporation (orinterfacing with) e-visit platforms.

SUMMARY

In general, in one aspect, a computer-implemented method includesreceiving a request from a consumer of medical services to engage with aprovider of medical services in real time over the Internet using acomputer-based brokerage system, accessing stored information related topast engagements of the consumer using the computer-based brokeragesystem, and determining allocation of a fee between the consumer and athird party for an engagement between the consumer and the providerbased at least in part on the information related to the pastengagements of the consumer.

In some aspects, a computer implemented method for use in a brokeragesystem that connects consumers of medical services with providers ofmedical services over the Internet includes managing utilization of thesystem by determining a distribution of cost between a consumer ofmedical services and an insurance carrier such that the cost to theconsumer increases with increased usage of the brokerage system by theconsumer.

In some aspects, a computer-implemented method, includes, in acomputer-based system for connecting consumers of medical services withproviders of medical services in real time over the internet, receivinga request from a consumer to consult with a service provider. The methodalso includes determining a distribution of cost between the consumerand an insurance company, the distribution of cost being based at leastin part on a type of service requested by the consumer and informationabout past interactions of the consumer with medical service providersusing the computer-based system.

In some aspects, a computer program product resides on a computerreadable medium and includes instructions for causing a computer toreceive a request from a consumer of medical services to engage with aprovider of medical services in real time over the Internet using acomputer-based brokerage system, access stored information related topast engagements of the consumer using the computer-based brokeragesystem, and determine an allocation of a fee between the consumer and athird party for an engagement between the consumer and the providerbased at least in part on the information related to the pastengagements of the consumer.

In some aspects, an apparatus includes a processor and a computerprogram product that resides on a computer readable medium. The computerprogram product includes instructions for causing the processor toaccess stored information related to past engagements of the consumerusing the computer-based brokerage system and determine an allocation ofa fee between the consumer and a third party for an engagement betweenthe consumer and the provider based at least in part on the informationrelated to the past engagements of the consumer.

Implementations of one or more of the above methods and system mayinclude one or more of the following features and/or software or devicesto perform one or more of the following features.

The information can include a total number of engagements by theconsumer during a period of time and/or a total financial expenditure ofan insurance company or another third party during a period of time.

Determining the allocation of the fee between the consumer and a thirdparty can include determining a percentage of a total cost to be paid bythe consumer.

The method can also include accessing health related information aboutthe consumer.

Determining the allocation of the fee between the consumer and the thirdparty can include determining the allocation of the fee between theconsumer and a third party based at least in part on the informationrelated to the past engagements and the health related information.Determining the allocation of the fee between the consumer and a thirdparty can include allocating the entire fee to the consumer if an amountpaid by the third party is greater than a threshold set by the thirdparty.

The third party can be an insurance carrier.

The method can also include displaying a price associated withconsulting with a particular service provider to the consumer on theuser interface. Displaying the price can include displaying a totalcost, displaying an amount to be paid by the insurance company, anddisplaying an amount to be paid by the consumer.

The method can also include receiving, from the consumer, a payment fora portion of the cost allocated to the consumer prior to connecting theconsumer to the medical service provider.

Determining the distribution of cost can include determining adistribution to limit overuse of the system.

Determining the distribution of cost between the consumer and theinsurance company can include determining a number of times the consumerhas interacted with medical service providers using the system during aperiod of time prior to receiving the request and comparing the numberof times the consumer has interacted with the medical service providersusing the system to a maximum number of times an insurance company willprovide a co-payment. The method can also include, if the number oftimes the consumer has interacted with the medical service providersusing the system exceeds the maximum number of times an insurancecompany will provide a co-payment, providing an indication to theconsumer that the consumer will be responsible for the entire cost.

The method can also include receiving a payment scale from the insurancecompany.

Determining the distribution of cost between the consumer and theinsurance company can include determining a total amount the insurancecompany has paid for a particular consumer using the system during aperiod of time prior to receiving the request, comparing the totalamount to a maximum amount an insurance company will provide inco-payments, and if the total amount exceeds the maximum amount theinsurance company will provide in co-payments, providing an indicationto the consumer that the consumer will be responsible for the entirecost.

The method can also include identifying one or more service providerssatisfying at least some of attributes in the request from the consumer,sorting the identified one or more service providers based on a cost tothe consumer, displaying the identified one or more service providers inan order based, at least in part, on the cost to the consumer, anddisplaying the determined distribution of cost between the consumer andan insurance company on the user interface.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a diagrammatic view of an engagement brokerage service.

FIGS. 2A, 5A-5D, 7, 8, 10, 12A, 12B, and 15 are screen images of a userinterface for an engagement brokerage service.

FIG. 2B is a flow chart for an interactive voice response systeminterface for an engagement brokerage service.

FIGS. 3, 4A-4D, 6, 11, 13, and 14 are flow charts of processes used inan engagement brokerage system.

FIG. 9 is a table of sample criteria used in an engagement brokeragesystem.

DETAILED DESCRIPTION Overview

The system described below provides an integrated information andcommunication platform that enables consumers of services to identifyand prioritize service providers with whom they should consult and tocarry out consultations with such service providers in an efficientmanner. Consumers are able to consult on-line with an expert serviceprovider, at a mutually convenient time and place, even when the twoparties are geographically separated. This integrated platform isreferred to herein as an engagement brokerage service (brokerage).

FIG. 1 shows an example system 100 implementing the brokerage service.The system 100 includes a computerized system or server 110 for makingconnections between consumers 120, at client systems 122, and serviceproviders 130, at client systems 132, over a network 140, e.g., theInternet or other types of networks. The computerized system 110 mayoperate as a service running on a web server 102.

The computerized system 110 includes an availability or presencetracking module 112 for tracking the availability of the serviceproviders 130. Availability or presence is tracked actively orpassively. In an active system, one or more of the service providers 130provides an indication to the computerized system 110 that the one ormore service providers are available to be contacted by consumers 120and an indication of the mode by which the provider may be contacted. Insome examples of an active system, the provider's computer, phone, orother terminal device periodically provides an indication of theprovider's availability (e.g., available, online, idle, busy) to thesystem 110 and a mode (e.g., text, voice, video, etc.) by which he canbe engaged. In a passive system, the computerized system 110 presumesthat the service provider 130 is available by the service provider'sactions, including connecting to the computerized system 110 orregistering the provider's local phone number with the system. In someexamples of a passive system, the system 110 indicates the provider 130to be available at all times until the provider logs off, except whenthe provider is actively engaged with a consumer 120.

The computerized system 110 also includes one or more processes such asthe tracking module 112 and a scheduling module 116. The system 110accesses one or more databases 118. The components of the system 110 andthe web server 102 may be integrated or distributed in variouscombinations as is commonly known in the art.

Using the system 100, a consumer 120 communicates with a provider 130.The consumers 120 and providers 130 connect to the computerized system110 through a website or other interface on the web server 102 usingclient devices 122 and 132, respectively. Client devices 122 and 132 canbe any combination of, e.g., personal digital assistants, land-linetelephones, cell phones, computer systems, media-player-type devices,and so forth. The client devices 122 and 132 enable the consumers 120 toinput and receive information as well as to communicate via video,audio, and/or text with the providers 130.

Limited by office hours and other patients, providers struggle with theidea of adding another service commitment to their existing workload.Patients sending queries to their providers can not expect an immediateresponse and are often asked to schedule an appointment for furtherevaluation. Providers are, however, often available at times that arenot convenient for their patients, for example, in the event of alast-minute cancellation. Providers also may be available for e-visitsduring otherwise idle times, such as when home, during their commute,and so forth. The brokerage supplements existing provider availabilityto allow whichever providers are available at any given time to providee-Visits to whichever consumers need a consultation at that time.Instead of relying on the unlikely availability of a specific providerfor any given consumer, the brokerage connects the consumer to allonline providers capable of addressing the consumer's needs. Thebrokerage has distinct features including the ability to engage in livecommunication with a suitable, selectable provider and the ability to doso on-demand.

One advantage that the brokerage provides is that the brokerageconstantly monitors the availability of a provider for an engagement andthus, consumers receive immediate attention to address their questionsor concerns, since the brokerage will connect them to available serviceproviders. In order to achieve such a level of availability, the systemassimilates the discretionary or fractional availability windows of timeoffered by individual providers into a continuous availabilityperception by consumers. Since many of the services offered to consumersare on-demand, consumers have little expectation that the same providerwill be constantly available, rather, they expect that some providerwill be available.

The computerized system 110 provides information and services to theconsumers 120 in addition to connecting them with providers 130. Thecomputerized system 110 includes an access control facility 114, whichmanages and controls whether a given consumer 120 may access the system110 and what level or scope of access to the features, functions, andservices the system 110 will provide.

The consumer 120 use the system 100 to find out more information about atopic of interest or, for example, a potential medical condition. Thecomputerized system 110 identifies service providers 130 that areavailable at any given moment to communicate with a consumer about aparticular product, service, or related topic or subject, for example, amedical condition. The computerized system 110 facilitates communicationbetween the consumer 120 and provider 130, enabling them to communicate,for example, via a data-network-facilitated video or voice communicationchannel (such as Voice over IP), land and mobile telephone networkchannels, and instant messaging or chat. In some examples, theavailability of one or more providers 130 is tracked, and at the instanta consumer 120 desires to connect and communicate with a provider, thesystem 110 determines whether a provider is available. If a particularprovider 130 is available, the system 110 assesses the various modes ofcommunication that are available and connects the consumer 120 and theprovider 130 through one or more common modes of communication.

The system selects a mode of communication to use based in part on therelative utility of the various modes. The preferred mode for anengagement is for both the consumer 120 and the provider 130 to useweb-based consoles, as this allows each of the other modes to be used asneeded. For example, consumers and providers may launch chat sessions,voice calls, or video chats from within a web-based console like thatshown in FIG. 2A, below. A web based console also provides on-demandaccess to records, such as the consumer's medical history, and otherinformation. If only one of the participants in an engagement has accessto a web console, the system 110 connects that participant's console towhatever form of communication the other party has available. Forexample, if the consumer is on the phone and the provider is using a webbrowser, the system 110 may connect the consumer's phone call to a VoIPsession that the provider can access through the web.

If the provider 130 is not available, the system 110 identifies otheravailable providers 130 that would meet the consumer 120's needs. Thesystem 110 enables the consumer 120 to send a message to the consumer'schosen provider. The consumer can also have the system 110 contact theconsumer in the future when the chosen provider is available.

By way of illustration, the system 100 connects members of healthcareplans with providers of healthcare products and services. For example,the service providers 130 may be physicians, and the service consumers120 may be patients. The service providers and service consumers mayalso be lawyers and clients, contractors and homeowners, or any othercombination of a provider of services and a consumer of services.

The system enables the consumer to search for providers that areavailable at the time the consumer is searching and enables the consumerto engage a provider on a transactional basis or for a one-timeconsultation. A consumer is able to engage a world-renowned specialistfor a consultation or second opinion, even though the specialist islocated too far away from the consumer to become a regular client,patient, or consumer. The consumer can use that specialist's advice whenconsidering services by a local service provider. For example, a patientin a suburban town with a rare condition may consult with a specialistin a distant city, and then, based on that consultation, select a localphysician for treatment.

FIG. 2A shows a page 134 of the main user interface to the brokerage.Many of the web-based functions are also provided by an InteractiveVoice Response (IVR) system, as discussed below. As noted the server 110sends web pages like the page 134 to the consumer 120 and the provider130 and receives responses from the consumer 120 and the provider 130.In some examples, the application server provides a predefined sequenceof web pages or voice prompts to the consumer 120 or the provider 130.FIG. 2 shows an interface intended for the consumer 120. A similarinterface is provided for providers 130, as shown in FIG. 10.

The web page 134 includes various elements to enable the consumer 120(to input information. These interface elements include buttons 136 aand text 136 b to enable the consumer 120 to select information and tonavigate the website Other standard elements (not shown) can includetext boxes to receive textual information and menus (such as drop-downmenus) to enable the consumer 120 to select information from a menu orlist.

Referring now to FIG. 2B, an example of logic for use in an IVR systemis shown. It is not intended that FIG. 2B be described in detail, sinceit is one of many possible logic flows for such a system and the exactdetails on questions and sequences is not important to an understandingof the concepts disclosed herein. In the IVR system, the voice promptsinclude questions or statements that elicit information from theconsumer 120 and the provider 130 as shown. The consumer 120 and theprovider 130 input information by speaking into the microphone of thetelephone or other terminal device and their speech is stored asreceived or converted to text using voice recognition. In some examples,the questions are multiple choice questions and the consumer 120 or theprovider 130 responds with spoken responses or by pressing buttons onthe keypad of their phone or other terminal device. The IVR systemfollows a series of flow charts like the flowchart 138 in FIG. 2B andcan include a menu system, in which case the consumer 120 or provider130 moves forward or backward, or exits the system by pressing certainkeys.

Referring now to FIG. 3, the computerized system 110 tracks 142 theavailability of providers 130 and consumers 120. When a provider 130logs 144 into the system 100, the provider 130 indicates 146 (such as bysetting a check box or selecting a menu entry or by responding to avoice prompt) to the tracking module 112 that he or she is available tointeract with consumers 120. The provider 130 can also indicate 148 tothe tracking module 112 (such as by setting a check box or selecting amenu entry or by responding to a voice prompt) the modes (e.g.,telephone, chat, video conference) by which a consumer 120 can beconnected to the provider 130. Alternatively, the tracking module 114determines 150 the capabilities of the terminals 122 and 132 theconsumer 120 and the provider 130 use to connect to the system (forexample, by using a terminal-based program to analyze the hardwareconfiguration of each terminal). Thus, if a provider 130 connects to thesystem 100 by a desktop computer and the provider has a video cameraconnected to that computer, the tracking module 112 determines 150 thatthe provider 130 can be engaged by text (e.g., chat or instantmessenger), voice (e.g., VoIP) or video conference. Similarly, if aprovider 130 connects to the system using a handheld device such as aPDA, the tracking module 112 determines 152 that the provider 130 can beengaged by text or voice. The tracking module 112 can also infer 152 aprovider's availability and modes of engagement by the provider'spreviously provided profile information and the terminal device throughwhich the provider connects to the system.

Providers participating in the brokerage network can have several statesof availability over time. States in which the provider may be availablemay include on-line, in which the provider is logged-in and can acceptnew engagements in any mode, on-line (busy), in which the provider islogged-in but is currently occupied in a video or telephonic engagement,and scheduled, in which the provider is offline but is scheduled to beonline at a designated time-point and can pre-schedule engagements forit. While not online, the provider can take messages as in offlinestate. Other states may include off-line, in which the provider is notlogged in but can take message-based engagements (i.e., asynchronousengagements), out-of-office, in which the provider is not acceptingengagements or messages, and standby, in which the provider is offlineand can be paged to Online status by the brokerage network if trafficload demands it (in some examples, consumers see this state as offline).

The operating business model for the provider network employs aremuneration scheme for providers that helps assure that the consumerscan find providers in designated professional domains (e.g., pediatrics)in the online mode. For example, selected providers can be remuneratedfor being in the standby mode to encourage their on-line availability incase of low discretionary availability by other-providers in theirprofessional domain. Standby providers are also called into the on-linestate when the fraction of on-line (busy) providers in theirprofessional domain exceeds a certain threshold. In some examples, thetransition of providers from standby to online and back to standby (incase of over capacity or idle capacity) is an automated function of thesystem.

The tracking module 112 transfers 154 information about the availabilityand the communication capability of the consumers 120 and the providers130 to the scheduling module 116 using, for example, one or morewell-known presence protocols, such as Instant Messaging and PresenceService (IMPS), Session Initiation Protocol (SIP) for Instant Messagingand Presence Leveraging Extensions (SIMPLE), and the ExtensibleMessaging and Presence Protocol (XMPP).

As noted, the system 100 includes access control facilities 114 thatcontrol how consumers 120 access the system and to what extent or levelthe services provided by the system are made available to consumers. Thesystem 100 also stores and provides access to consumer information(e.g., contact information, credit and financial information, creditcard information, health information, and other information related tothe consumer and the services purchased or otherwise used by theconsumer) and provider information (e.g., physician biographies, productand service information, health related content and information and anyinformation the provider or the health plan wants to make available tomembers) and the access control facility 114 can prevent unauthorizedaccess to this information. In some examples, the system 100 exports theconsumer information for use in a provider's office or other facility.

The system 100 interacts with consumers and available data sources toposition and direct their health matters to appropriate care providers.Consumers can use various tools of physician and provider profiling toexercise choice in selecting the providers they wish to interact with.The brokerage facilitates the communication between the consumer and hisselected providers, allowing the consumer to follow-up as needed toestablish a comfort level in his care. The brokerage supports transferof these communications and any other results of the eVisit tonon-virtual care points if such escalation is needed.

The brokerage can be considered as a first tier of medical care that ismade available to consumers at home or at other locations. This firsttier precedes typical entry points into a medical care setting, e.g., aphysician's office or an emergency room. The brokerage enables consumersto explore concerns on, new or existing medical issues without the needto incur the time, cost, and emotional burden typically associated withthe office visits or trips to the emergency room. To deliver such acomfort level, the system provides immediate access to tools that helpdefine health issues, as well as, access to the appropriate automatedand human mediated interventions. Consumers can discretionally engage(or escalate) the level of care they need to gain confidence in theirmanagement of such issues. The consumers' choices in this area span boththe type of credentials of the provider they interact with (e.g., anurse versus a board certified specialist), as well as the level ofintensity (mode and frequency) of their communications (e.g., messagesversus full video dialogue). The brokerage can export the informationand workup gained during an encounter to a subsequent tier of services,such as a specific medical office or the ER (as well as care managementservices if offered by the consumer's health plan, hospitals and soforth). As such, the brokerage manages more costly medical serviceconsumption (demand management) and serves as a pervasive tool forimpacting basic medical care and follow-up and encourages appropriatehealth behaviors for the customer population at large.

There are various models for how consumers may gain access to thesystem. Consumers may purchase access to the system through a variety ofmodels, including direct payment or as part of their insurance coverage.Health plans may provide access to their members as part of theirservice or as an optional added benefit. In some examples, health plansmay receive information about their members' use of the brokerage toallow, for example, better allocation of resources and overallmanagement of member's health care consumption. Employers may purchaseaccess to the brokerage for their employees through whichever healthplans the employer offers. Self-insured employers may purchase accessfor their employees directly with the brokerage. Providers may becompensated in several ways and may offer their services to thebrokerage either independently or as part of a framework such as aprovider network.

Similarly, there are numerous ways the brokerage can be packaged. As ahealth plan benefit, the brokerage expands a health plans ability tomanage health care service consumption by their members. A health planmay provide access to the brokerage through an existing web portalthrough which members access benefit information and interact with theirhealth plan. As an employee benefit, the brokerage supplements theemployee's health coverage and may be presented, for example, through ahuman resources web site. In a direct-to-consumer situation, consumersmay access the brokerage directly through its own web page. In someexamples, the brokerage is implemented as an enterprise software systemfor a call center, such as one operated by a health care provider.Linked to other institutional users of the system (e.g., otherparticipating providers), this can allow the provider to provideservices to its patients that it cannot offer itself, such as 24-hourspecialty consultations. The brokerage may also be used by a providerpractice to allows its practitioners to provide care to the brokerage'smembers (and generate revenue) during off-hours or as a preliminarystage to office visits. This may also eliminate the need for an officevisit with a primary care physician just to get a referral to aspecialist.

The brokerage provides compensation for products and services provided.Access to the system 100 may be provided on a subscription basis, withconsumers paying a fee (either directly or indirectly through anotherparty, such as a healthcare plan or health insurance provider) to beprovided with a particular level of access to the system. In exchangefor providing products or services, the service provider may receivecompensation from the consumer or from an organization that pays for theproducts or services on behalf of the consumer, such as a health plan ora health insurance company. In instances in which the consumer paysdirectly, the operator of the interface to the system that connected theconsumer to the service provider may be compensated. In one embodiment,the consumer pays the operator, which keeps a portion (e.g., apercentage, a flat fee, or a co-pay) and pays the remainder to theservice provider. In another embodiment, the consumer or the serviceprovider pays a flat fee or percentage of the fee for the engagement tothe operator. Where the service provider's compensation is paid by ahealth plan or insurance company, the operator may be paid a flat fee ora percentage of the fee for the engagement transaction by the healthplan or insurance company. Alternatively, the consumer or the serviceprovider or both may pay a fee (a co-pay or service fee) to the operatorfor providing the connection.

The Consumer Interface

Initiation of an Engagement

A consumer 120 engages with the brokerage system 100 to access a serviceprovider 130. Several types of engagements may exist. Examples of theseare described with respect to flowcharts in FIGS. 4A to 4D and userinterface screens in FIGS. 5A to 5D.

Referring now to FIG. 4A, a process 160 for establishing aconsumer-initiated engagement is shown. In a consumer-initiatedengagement, a consumer logs in 162 and communicates 164 a new matter hedesires assistance or guidance on to the brokerage, for example, ahealth concern. For example, this is done on a web page 166, as shown inFIG. 5A. A component of the brokerage system 100, such as the consumeradvisor discussed below, assists the consumer in consolidating 168 hisquestions and helps select 170 the appropriate providers to answer them.The web page 166 includes some initial questions 172, and another webpage 174, in FIG. 5B, provides a user interface for entering additionalcriteria 176 to find a provider. A results page 178, in FIG. 5C, allowsthe consumer to select a specific provider 180 from a list 182 ofproviders identified based on the search criteria. Once a provider isselected and a mode of engagement is chosen 184 (see below), thescheduling module 116 establishes 186 the new engagement. In someexamples, the brokerage associates 188 a unique identifier withparticipating consumers which can be used in subsequent interactionswith the brokerage, such as associating records from multipleengagements. The consumer's health plan membership number or othersimilar, pre-existing identification can be used 190. If the consumerdoes not already have 192 a number, one is generated 194. The uniqueidentifier can be used by the consumers to save their planned engagementfor later retrieval.

Referring now to FIG. 4B, a process 196 for establishing a follow-up orprescheduled engagement is shown. Once an engagement is established 186as in FIG. 4A or as one is completed 198, the two parties can instruct200 a component of the system 100, such as the scheduling module 116, topursue the established engagement or a follow-up engagement atpre-defined schedules or at future time points. The system uses 202e-mail, automated telephone communication, or any other method ofcommunication to establish a convenient time for both parties toaccomplish the follow-up and then prompts 204 them to do so 206.

Referring now to FIG. 4C, a process 208 for a standby engagement isshown, with a user interface on a web page 210 in FIG. 5D. A standbyengagement is similar to a consumer-initialized engagement. In a standbyengagement, the consumer selects 212 a provider 180 or type of providerand requests 214 that a component of the system 100, such as thescheduling module 116, to notify the consumer by an appropriatecommunication, for example, e-mail, text message, or an automated phonecall, when the selected provider is online and accepting engagements. Inthe example of FIG. 5D, the user has chosen to be called and input aphone number 216 and a limit 218 as to how long she will wait. Theconsumer request is placed 220 in a queue for the specific requestedprovider who is off-line (or for a type of provider for which allqualified providers are off-line). When the system determines 222 thatthe provider is available, the system notifies 224 the consumer. Whennotified, the consumer logs in 226 and is connected 228 to the provider.

As an option, a standby list for a provider may provide preferentialqueuing for some consumers. For example, preferential queuing may beprovided based on prior engagements with the provider (e.g., preferenceis given to follow-up engagements) or based on a service tier (e.g.,frequent user status) of that consumer. The brokerage can be configuredsuch that it collects information about the consumer (e.g., answers toinitial intake questions) and provides the collected information to thespecific service provider prior to initiating any further engagements.For example, a consumer can store information during aconsumer-initiated engagement as described above, park the information,and wait to be contacted when the specific selected provider isavailable.

Referring now to FIG. 4D, a process 230 for an interventional engagementis shown. In addition to consumer-initiated engagements, a health plan(or another authorized entity) automatically instructs 232 the system toschedule 234 an engagement with one of its members. This scenario may beemployed, for example, when a health plan member is consuming 236 costlycharges or exhibits a high risk score. The system may also be authorizedto automatically pursue 238 a low-intensity telephonic follow-up withmembers that would otherwise not be contacted for follow-up (e.g.,Medicare or Medicaid patients).

Provider Selection

One capability of the brokerage is to extend a retail-like experience tothe consumer. Consumers are able to spend time on the system to exploreits participating providers whether they are currently available or areexpected to be available at some other time. While the system can assistthe consumer in identifying the most appropriate providers (see theconsumer advisor function, below), it also allows the consumer to filterthe provider list based on his preference and access a view of aprovider availability matrix that changes as providers go on and offline.

An example of an interface by which consumers can select providers in avariety of ways is shown in FIG. 5B, mentioned above. In the health-carebased example of the illustrated page 174, various criteria 176 can beused to filter the available physicians. Basic details 240 indicate theconsumer's preference for the type 240 a and gender 240 b of theprovider and what modes of communication 240 c the consumer wants to beable to use. The user can also specify demographics 242 includinglocation 242 a and languages spoken 242 b. Qualifications 244 mayinclude education 244 a, years of experience 244 b, and various othercriteria 244 c. The consumer's health plan may offer additionalsearching criteria 246, such as whether a provider “must be in-network”246 a or whether the consumer can consult with an out-of-networkprovider 246 b. A consumer can also use a search box 248 to search for aprovider by name.

Consumers may select providers according to attributes of the provider,such as a geographical area where the provider is located or whichprofessional organizations have accredited the provider (e.g., whether adoctor has board certification in cardiology). Any metrics within theprovider profile (discussed below) can be used to define a list ofproviders that meet the consumer's preferences.

Once the consumer enters her search criteria 176, the results are shownon the web page 178 in FIG. 5C. As mentioned, a list 182 of providers ispresented. This list may indicate each providers name 250 and rating 252and whether the provider is available 254. For the selected provider180, additional details are shown, including her picture 256, specialty258, demographic information 260, what types 262 of connections she canuse for an engagement, and personal information 264. Tools 266 allow theconsumer to initiate or schedule an engagement.

Providers already associated with the consumer may appear on theconsumers' short list. Association may be based on historicalengagements and may extend to the health plan's feed of claims (i.e.,all providers that submitted claims for the consumer). When reviewingthe list of historical engagements, consumers are able to access theengagement audit and the ranking they have attributed to any engagementsin the past.

In certain modes of deployment, there are functional attributes that mayimpact the consumer's selection. In most health-plan distribution modes,consumers may opt (or be limited) to see only providers that are“in-network” according to their insurance coverage product. Selecting an“out-of-network” provider may incur higher out-of-pocket costs. Anotherexample relates to a deployment of the system in disease management andhealth coaching settings (e.g., a call center). In this case, the planmay require that the consumer can select only nurses that are associatedwith the disease management program with which the consumer isassociated.

Regulations introduced by the federal government in August, 2006,require all federal bodies offering medical coverage (includingMedicare, Medicaid, and military, and federal employee plans) to publishtheir ratings of health service providers (physicians and hospitals) tothe general public. The system can allow the consumer to search suchsites automatically for a selected provider prior to an engagement.Other sources of reference data may include state publications onmorbidity, mortality, and legal actions against providers, or databasesmaintained by third parties.

Once a consumer has defined a collection of criteria to filter and finda provider, the system can offer tools to shorten the process in thefuture. Consumers may be able to save criteria-sets as named searchesand benefit from notifications when a search list surpasses a certainlevel of availability that may encourage the consumer to log in andcommunicate with a provider.

Modes of Engagement

The brokerage allows consumers to engage provider's e.g., healthprofessionals “on demand” based on provider availability. Engagementscan be established in various ways, including:

-   -   1. Passive browsing—Reference health content is accessed on the        brokerage's website. The website can support the use of licensed        content packages from other vendors to meet the variable        preferences of health plans. For example, key content vendors        include Healthwise™, ADAM™, Mayo Clinic™ and HealthDay™ Content        libraries provided by such vendors offer a combination of        articles, imagery, interactive tutorials and related tools that        allow consumers to access content relevant for their health        issues. Many health plans and major employers already possess a        license for the use of one of these content packages.    -   2. Health Risk Assessments—The system acquires information from        consumers through automated interaction (e.g., rules-based        interaction) in order to crystallize their needs (e.g., medical        risks) and better direct them. Assessments span from general        health to very specific medical conditions and follow a path of        questioning that dynamically tailors itself based on information        already retrieved (e.g., using predefined rules). As assessments        progress, the system constructs engagement suggestions that the        consumer can exercise. Each suggestion represents both the        question to the provider and the type of provider appropriate to        answer it. Consumers may choose to simply launch such        engagements or apply their own discretion as to the phrasing and        the selection of the recipient provider. This is discussed in        more detail below in the context of the consumer advisor.    -   3. Asynchronous correspondence—The lowest level of true provider        interaction is by way of secure messaging. The question or topic        of the engagement is sent to a selected provider (whether online        or not) and can be answered by this provider at her leisure.        Turnaround times are monitored by the system and are part of the        credentials of the provider used for her selection by consumers.        The system informs the consumer once a response has been        received and can allow the consumer to redirect the question if        he needs more urgent response time. For example, typical types        of asynchronous correspondence include e-mail, instant        messaging, text-messaging, voice mail messaging, VoIP messaging        (i.e., leaving a message using VoIP), and paper letters (e.g.,        via the U.S. Postal Service).    -   4. Synchronous correspondence—Several forms of synchronous        correspondence allow the consumer and the provider to engage in        real-time discussions.    -   5. Synchronous text correspondence—This may be referred to as a        “Chat” module where both sides of the engagement type their        entries in response to each others' entries. The form of        communication may be entirely text based but is still a live        communication. Examples include instant messaging and SMS        messaging.    -   6. Web-based teleconferencing—The use of broadband network        connections allows for real-time voice transmission over the        Internet in what is referred to as full duplex (i.e., both voice        channels are open at the same time). Consumers can opt to have a        voice conversation with their providers using, for example,        their computer's speakers and microphone. Web-based        teleconferencing may use VoIP, SIP, and other standard or        proprietary technologies.    -   7. Telephonic conferencing—Consumers who wish for a direct        telephonic communication with a provider or who are not        comfortable using their computer may use a traditional telephone        for interaction with a provider. The consumer may use a dial-in        number and an access code that connects him to the brokerage's        servers. Providers are linked to the servers via VoIP, other        data-network-based voice systems, or their own telephones.        Telephonic conferencing may also allow consumers to request        “call me now” functions, in which the provider calls the        consumer (directly or through the brokerage).    -   8. Video conferencing—The system can support video conferencing        to allow consumers to exhibit physical findings to providers if        such disclosure is needed. Consumers and providers may also        simply prefer face-to-face communication, even if remote. Small        digital cameras, referred to as webcams, attached to or built in        to personal computers or laptops can be used for this purpose.        Video conferencing can be provided by standard software or by        custom software provided by the brokerage. Alternatively,        dedicated video conferencing communication equipment or        telephones with built-in video capabilities can be used.    -   9. Semi synchronous correspondence—Some engagements of a        consumer with an online provider include both synchronous and        asynchronous interactions. Part of the engagement takes place by        immediate messaging between the two, but the provider may ask        the consumer to take occasional asynchronous assessments if, for        example, a generic line of question is desired. This allows the        provider to operate more than one consumer engagement at a time        while each consumer is constantly engaged. For example,        semi-synchronous correspondence includes a combination of        e-mail, instant messaging, test messaging, voice calls and mail        messaging, and VoIP calls and VoIP messaging.

Interactive Voice Response Engagements

Interactive Voice Response (IVR) systems allow for the deployment ofinteractive audio menus over the phone. The caller can navigate betweenoptions, listen to data-driven information, provide meaningful input,and engage system functions. IVR engagements extend the reach of thesystem to the telephone as a portable consumer interface to launch anengagement in addition to the Web-based interface. Consumers select apin code on the application to authenticate their identity if they callin. Several types of engagements can be carried out through an IVRsystem using logic like that shown in FIG. 2B. For dial-in engagements,the consumer calls in and invokes a telephonic engagement with anavailable provider. The IVR system extends the consumer's ability toselect a provider to the phone so that the consumer's interactionresembles one carried out on the Web.

The IVR system can also be used proactively to pursue consumers who needa follow-up. At the time of a follow-up, the system recalls the providerwith whom the follow-up is desired (or the type of provider in case thefollow-up is not restricted to a specific provider), identifies that theprovider is available for an engagement, and attempts to contact theconsumer over the phone to establish a connection for the engagement.Once contacted, the consumer can decline or ask postpone the call. Ifthe consumer takes the call, the connection is made. When consumers arepursuing an engagement with a provider that is either busy or currentlyoffline (e.g., a specific provider or a type of provider with fewparticipants), the IVR system allows the consumer to park in a standbymode until the provider is available. When the provider is available,the system calls the consumer, identifies the provider to the consumer,and verifies that the consumer is still interested in pursuing the callwith the provider. If the consumer is still interested, an engagement isconnected.

In addition to launching engagements, the IVR interface allows consumersto interact with other services offered by the brokerage. For example,consumers can instruct the system to fax a transcript of theirinformation to a fax machine that the consumer identifies by keying inor speaking its phone number. Using such a function, a consumer makeskey information available to, e.g., emergency room personnel or to aprovider in an office visit. without the need to plan, collect, print,and carry the information to that encounter.

IVR hardware is readily available from telecommunication vendors and canbe programmed to operate in the context of the brokerage framework.Authentication is provided through a PIN number or by other standardmethods.

Engagement Auditing

In some examples, material elements of an engagement are audited by thebrokerage to establish a work-up record of the consumer. Such a recordof consumer entries, recordings, and provider notes, together with timestamps and identification of registrars, is available to the consumer atany time for future reference. A consumer may choose to share thisrecord with other providers within the brokerage or to export it to anexternal point-of-care such as a provider office, an emergency room, acare manager, or an external record management system such as a regionalhealth information organization (RHIO) (and to similar entities innon-medical implementations). Auditing may also include various degreesof automated entry of standardized coding to allow effective rule-basedmoderation of the system based on clinical (for example) insightscaptured during the engagement. In some examples, the manners ofauditing and coding are compliant with the Health Insurance Portabilityand Accountability Act (HIPAA).

Engagement Recording and Transcription

The system 110 allows an engagement conducted using a voice technology,such as telephone, VoIP, or a video call over the web, to be recorded.As the system generates an audio file, it offers consumers servicesassociated with the file. Based on a consumer request or setting toproduce a transcript, the system forwards the file to a third partyvendor to perform transcription of the file and return a textualrepresentation of the engagement. Such text is incorporated into theconsumer's record, communicated to an external party, or used as thebasis for future engagements. In some examples, the transcription may beperformed by voice recognition software. Transcription services can bebundled with encoding and translation services. The consumer may alsorequest that the audio recording be made available over the phone or asa data file to a third party (e.g., the consumer's personal provider).In some examples, consumers are able to replay the recording from eitherthe web client or a telephone as part of the IVR system.

Engagement Redirection

In some examples, a consumer redirects an active engagement to anotherprovider or provider type. A consumer may also redirect an engagement toemploy a different mode of communication with the current provider(e.g., move from a text chat to a phone conversation). The audit of theinformation and work up established before the redirection becomes thebasis for the new engagement. In some examples, a consumer redirects anengagement that concluded in the past as a way to continue follow-up onthe same issue.

Consumer Advisor

Another utility in the brokerage, the consumer advisor, assistsconsumers in determining what actions to take, for example, which typesof providers to consult. The consumer advisor acts as a facilitator ofengagements between consumers and providers, similarly to the way anurse might interact with a patient in a health care system. In someexamples, the consumer advisor is operated using a rule-driven engineembedded in the system 110 that draws from both consumer intake data andprogrammed clinical knowledge. The consumer advisor helps the consumeridentify issues that the consumer should discuss with a provider in thesystem, collects data to contextualize and shorten the time needed forthe discussion, and helps orchestrate engagements with the appropriatetype of providers, presenting the collected intake information to theproviders prior to the commencement of the engagement itself.

The consumer advisor walks the consumer through the process of using thebrokerage and helps the consumer acquire the appropriate services,minimizing the time spent and cost to the consumer in determining whichservices to use. In some examples, the consumer advisor packages orformats the information it has collected to export it to a non-virtualprovider (e.g., a consumer's primary care physician) for furtherfollow-up, even if the consumer did not end up in an engagement. Theconsumer advisor operates as an assistant to the provider during anengagement, working directly with the consumer.

FIG. 6 shows an example process 280 used to implement the consumeradvisor. An intake stage 282 asks 284 the consumer a series of questionsthat either pin-point the area of concern or capture relevantinformation about the needs (for example, the health) of the consumer inthat area. In some examples, this process is equivalent to what thehealthcare industry calls a Health Risk Assessment (HRA). The intakestage 282 identifies or defines 286 one or more of a consumer's needs orproblems. The result of the intake stage 282 include a list or anarrative summary of the issues that should be presented to theprovider. The intake stage enables the consumer to exclude topics heprefers not to discuss or to add topics manually. The result of theprocess is what physicians or lawyers call intake, a desired step in afirst-time office visit or client engagement. This relieves providersfrom performing the typical extensive intake process during anengagement. Because the information the provider would collect hasalready been gathered by the intake stage 282. In the health careexample, the intake stage 282 covers topics that extend to both medicalconditions and issues (e.g., pain in left shoulder, not associated withexercise) as well as general health and wellness assessment profiling(e.g., the patient is a female over 40 and had not had a mammogram, thepatient is overweight, the patient is having trouble sleeping).

The information obtained from the intake stage 282 is analyzed 288 in ananalysis stage 286 to determine a list of topics concerning healthissues. The consumer advisor presents 290 the list of topics about theconsumer's needs to the consumer and allows the consumer to furtherrefine 292 the list by adding or removing topics. In the health careexample, generating the list includes codifying the conditions, issuesand general state of health and wellness of the patient to allowinternal profiling of the patient and to facilitate future engagements.Once a list of topics is defined, the analysis stage 286 determines 294an engagement action plan or agenda for the consumer, suggesting thetype of providers most appropriate to discuss each topic and therelative priorities of such discussions. A web page 296 presenting anexample agenda 298 is shown in FIG. 7. The consumer advisor maysupplement 300 the agenda with links to consumer content information toeducate the consumer about the condition or issue prior to hisengagement with the provider. The action plan is output 302 in severalways. In some cases, a consumer prints (or downloads and saves) theaction plan and takes it to his live provider. In some cases, the actionplan is transmitted to the consumer's live or primary providerautomatically.

The action plan is also output 302 to the scheduler module 116, whichlocates providers and establishes engagements, as discussed above withregard to FIG. 4A, for the most appropriate provider(s) available foreach of the action plan's item(s). The consumer uses the system 100 toengage such provider(s) or to find other available providers, and tosequentially engage providers appropriate for each of the topics on theconsumer's engagement action plan. The consumer can also re-prioritizethe items in the action plan and save the action plan to use at somepoint in the future. A consumer may use the list as basis for enteringinto multiple engagements (with multiple providers) or allow the firstprovider engaged (or the consumer's personal provider, such as a primarycare physician) to review and orchestrate the management of all issuesin the list. The scheduler module 116 allows the consumer to use thesystem 100 to engage available providers in any suitable mode (forexample, by chat, by video conference, or by voice communication) or toenter the standby list for providers currently not online.

In certain engagements, the provider enhances interaction with theconsumer by using a re-assessment process 304 to acquire furtherinformation about the consumer's condition. During an engagement 306,the provider invokes 308 the re-assessment process 304 to cause theconsumer advisor to interact 310 with the consumer on one or morespecific intake assessments or assessment forms. For example, where theinitial intake did not determine the possibility of a specific issue orcondition, a treating physician, after consultation with the consumer,can ask for a specific intake process to be given or taken again (forexample, where the consumer omitted an important symptom). Once there-assessment is completed, the treating physician or a new physician(in the health care example) can have 306 a new live engagement with theconsumer.

This assessment process 304 may be repeated, with the consumerundergoing further assessment or repeating assessments to collectfurther information for the provider. In some examples, the intake stage282 determines, based on information provided by a previous provider,for example, that the consumer needs a re-assessment and the nature ofthe re-assessment, such that when the consumer returns to the intakestage 282, the consumer is prompted as to whether the consumer wants toproceed with the re-assessment or perform intake for a new engagement ordifferent condition or disease.

In some examples, the consumer advisor includes a health improvementfunction to assess a consumer patient's current overall health andwellness state, a specific area of the health and wellness state, ortreatment for a specific condition, issue or symptom. A profilingoperation 312 is performed using the data collected by the intake stage282 to form a profile of the patient. This data include the consumer'sgoals, where the consumer wants the consumer's health state to be in thefuture, and desired changes in the consumer's overall health andwellness state or in a specific area of the consumer's health andwellness state (e.g., body weight, BMI, cholesterol level, etc.), ortreatment for a specific condition, issue or symptom. After developing314 the profile and analyzing 316 it, the consumer advisor lists 318 theactions that the consumer should take to achieve these goals andincorporates 320 the actions into the consumer's action plan. Inaddition to recommending treatment, the health improvement function alsopromotes actions in the area of education, including static content andactive engagements.

The health improvement function also determines a regimen for theconsumer to follow to achieve the goals. Where necessary, the consumercan be directed to the scheduler module 116 to connect the consumer witha provider to assist in developing the regimen. For example, theconsumer can meet with dietician to assist in the development of adietary regimen or a personal trainer for the development of an exerciseregimen. The consumer can periodically interact with the healthimprovement function to track her progress toward her goal. Theinformation about the consumer's progress and updates as to theconsumer's profile information are collected using the intake stage 282.

The steps of the process 280 may be implemented in a single module or inseveral functional components or modules including an intake module andan advisor module. The consumer advisor may be implemented as a modulewithin the server 110, similarly to the tracking module 112 or thescheduling module 116, or it may be a self-contained module. Thescheduling may be carried out by the scheduling module 116 through aninterface to the modules carrying out the advisor process. To providecontinuity to consumers, the interface may be implemented as part of theinterface shown in FIGS. 5A-D.

The consumer information collected by the intake process may be storedin the databases 118 as part of the overall brokerage. In some examples,the consumer information is protected and secured from unauthorizedaccess and in compliance with the various legal requirements for storingprivate consumer information (for example, HIPPA governs access to anindividual's health care information). The database 118 may also theprocess logic and rules data including the business logic of anapplication or rules for a rules engine that implements the consumeradvisor module.

The system 110 keeps track of where the consumer 120 is in any of theprocesses so that the consumer 120 can log out and, upon his return, betaken to the same point where he left. After the consumer 120 hascompleted a section of his action plan, for example, after a patient hasbeen successfully treated for a condition, the system 110 archives therelated data and stores it as part of a virtual consumer record systemin the databases 118. In some examples, a virtual patient record systemis used as a source of data for various health assessment and healthrisk studies. Patient data can be accessed anonymously, for example, sothat researchers can study patient data without obtaining the identityof any of the patients.

Auxiliary Services

Other services can be incorporated into the overall brokerage. Suchauxiliary services extend the completeness of the service's offering orallow for advanced functions that can improve the end-user experience ina substantial way. The brokerage architecture allows incorporation ofsuch auxiliary services either as part of the brokerage framework or asplug-ins using 3^(rd) party vendor components. Such auxiliary servicesmay be positioned inside the brokerage console to facilitate aconsolidated user experience independently of who ultimately providesthem.

A consumer data repository includes collection of parametric andnon-parametric data. In addition, the repository holds consumerinformation, such as health and wellness information. For prescriptionfilling, a provider prescribes medications to a patient over the web andsubmits the prescription to a local pharmacy for pick up. Such servicesmay include components of prescription clearinghouses like SureScript™or RxHub™. Where appropriate, the system is designed to interface withsuch services. There are, of course, legal constraints on suchofferings.

In targeted self-help programs, a provider may advise a consumer toengage in a certain action plan that uses only intermittent providerinvolvement and is primarily focused on ongoing interaction by theconsumer with computerized modules. The brokerage may offer informationregarding a consumer's current eligibility for services or benefits aswell as general information on offerings, programs, and enrollment inspecial products offered by, for example, a health plan that isproviding the brokerage to its members. This information may also comefrom employer-operated benefit services. If consumers are enrolled inhealth-related financial products like health spending accounts, variousupdates on current standing are be presented through the console. Thisinformation is updated, linked to, or summarized by the plan, theemployer, or an affiliated financial institution managing the consumer'saccount. Similarly, retirement plans or brokerage accounts might belinked, for example, if the brokerage is provided by the consumer'semployer or bank to provide financial planning advice. Consumers may begiven access to relevant and targeted clinical content from packagesthat are included in a specific service subscribed to by or on behalf ofthe consumer. These may include packages related to clinical, health,wellness (e.g. diet and exercise), preventive medicine, medication,coaching, mental health, and other disciplines.

Information Portability

The brokerage extends the result of any engagement to a physical pointof care or service provider to allow continuation or escalation ofservices beyond those provided in the electronic encounter. For example,a textual transcript of an engagement is forwarded to a desiredprovider. If the provider is a participant in the brokerage, theprovider accesses the transcript directly. If the provider is not aparticipant, other modes of access to the transcripts may be used, suchas e-mail or fax or temporary access may be given to the non-subscribingprovider. In some examples, the service may compensate a provider forreviewing a summary of his client's on-line engagement with anotherprovider. This keeps the primary provider informed, leading to betterservice for the consumer, and making the eVisit system more palatable tothe primary provider.

The brokerage may also supplement the record of the engagement withadditional information, such as pointing out to a physician whattreatment options the patient's health plan would prioritize for anillness noted in the record, or what preventative treatments the patientmay be due for.

A consumer may opt to receive or forward his entire record on thebrokerage's system for either safekeeping or as part of a recordtransfer to another service, for example, if the consumer changes healthplans. In some examples, the brokerage allows consumers to request sucha transcript to be transmitted in electronic form or to be loaded onto aselected medium. Outbound communications can be explicitly approved bythe consumer, for example, to conform to HIPAA requirements for managingprotected health information (PHI) or other consumer privacy policies orregulations.

Assuring Treatment Continuity

Consumers are more likely to use the brokerage if they perceive it as avalid tier in their relationships with their service providers, which ismore likely if there is continuity between engagements, whether live oron-line. The workup performed on the brokerage facilitates theconsumer's non-virtual relationship (rather than being redundant orcontradictory) and thus encourages participation by both consumers andproviders. The brokerage provides several features to achieve this goal.In some examples, the brokerage engages concierge practices in keygeographic locations to provide non-virtual care to consumers who areotherwise managed only through brokerage-based engagements.

A service guarantee is provided to the consumer that any workupperformed on the system is made available to his local service provider(e.g., his primary care physician) or requested point of care within aset number of business days electronically and another number ofbusiness days by paper statement. The consumer can also receive, for hisown safekeeping, an assurance in the form of transcripts of eachtransaction.

For providers who do not participate in the brokerage, a referralguarantee is provided to the consumer's local service provider (e.g.,his primary care physician) that her role in coordinating the care tothe consumer will not be harmed. As such, the system acknowledges thelocal service provider's role visually to both the consumer (e.g., whilein engagement with another provider) and to any participating providerswith whom the consumer interacts. The designation of a certain localservice provider as, for example, the PCP of the consumer, automaticallytriggers a behavior in the system that continues to update that localprovider on the activity around “her” consumer. Another function thatcan further cement the role of the local service provider is anautomated referral in which the participating provider can refer theconsumer to an office visit only with that local service provider ifadditional workup is needed. This allows the local service provider toincrease her visibility and receive more traffic merely by cooperatingin her customers' use of the brokerage.

In some examples, a quid-pro-quo feature extends the treatmentcontinuity offered to the consumer beyond forwarding engagementinformation to a non-virtual service provider. It allows consumers tocontinue a virtual engagement (or follow up on one) with a participatingprovider operating a real-world practice. Because participatingproviders have access to the brokerage's online interface, transitionsbetween on-line and live providers are more informed. The consumerbenefits from being able to pick up where he left off in the on-lineengagement and assure continued documentation of his non-virtual visitin his service-based records.

Consumer Incentives

In some examples, health plans or other entities offering the brokerageto their customers incorporate automated incentives. Such incentivesreward consumers for activities that yield favorable health outcomes (inthe example of a health-plan-provided service). Incentives are providedto encourage consumers to, for example, become educated about the natureof a chronic condition with which the consumer has been diagnosed,engage in a conversation that yields advanced detection of a majorhealth issue, perform online follow-up on conditions that warrant it(e.g., coronary artery disease or Diabetes), and participate inengagements that yield higher drug regimen compliance in select medicalconditions. The system allows such incentives to be distributedautomatically and promoted to appropriate consumers to encourage, forexample, desired health behavior and medical management.

Interface with External Data Sources

To facilitate engagements between the consumer and the provider, thesystem acquires information from available systems automatically anduses the information to prepare providers at the beginning of anengagement. Such interfaces include both synchronous (e.g., webservices) and batch updates from, in the example of health care,eligibility data, claims data, Pharmacy Benefit Management (PBM)information, predictive modeling, provider feeds relevant for consumerreferrals, other standard-coding feeds using, e.g., ICD, CPT, HCPCS,NDC, SNOMED, or LOINC, formulary information relevant for Rx drug choicedetermination and preference, Customer Relations Management systems(CRM), and external messaging systems and queues (e.g., My Yahoo!,personalized RSS feeds).

Management and Analysis of Raw Data Inputs

In some examples, the brokerage accepts raw data inputs such as claims,pharmacy data, and lab data, from a variety of sources typically used bylarge clients (e.g., health plans, care management companies). Thesystem validates the correlation between incidental entries in the rawdata and the profile of the consumer. To do this, the system appliescustomizable analytic rules that tag a consumer as diabetic, forexample, based on lab results, rather than flagging a consumer as adiabetic merely because he had a test to exclude diabetes (e.g., wherethe ICD code for the text doesn't indicate its outcome).

Service Providers

Provider Enrollment

Service providers are the individuals responding to consumers queriesand participating in engagements. For example, in a health care setting,service providers include doctors, nurses, and other medicalprofessionals. Such providers participate in the brokerage whilemaintaining their affiliations they may have with any sort ofprofessional engagement in the non-virtual world (e.g., a hospitalappointment, a clinic or a private practice, partnership in a law firm).Providers on the brokerage network are verified to hold their claimedcredentials prior to being permitted to accept engagements withconsumers. Once verified, providers agree to the terms of the brokerage,such as payment for their time in performing engagements, the protocolof conduct desired, and the ramification and distribution of liabilityin case of violations of that protocol. These are similar to theagreements providers would make when joining a group practice or ahospital in the non-virtual world. An example web page 330 for one stagein the enrollment process is shown in FIG. 8.

Prior to joining the brokerage network, a provider establishes a profilethat allows consumers to select him as the target service provider of anengagement. Providers are profiled using verifiable information fromprovider registries (e.g., the American Medical Association (AMA) forphysicians or the American Bar Association (ABA) for lawyers) as well asby a self-statement. The profile is used for several purposes, includingdetermining the relative cost of the provider's time to either theconsumer or the brokerage sponsor (e.g. a health plan that is paying forthe service), and providing consumers with information that may berelevant to their choice to engage one provider versus another. Someinformation about the provider is verified by the brokerage (e.g., TaxID, education, professional certification, demographics, and contactinformation), and some is acquired during the provider's participationon the brokerage. Such data may include length of service, number ofengagements, consumer satisfaction, projected availability, etc. Aprovider may also provide a general introductory note, a picture, andvoice and video welcome snippets. Providers may also add otherinformation they deem relevant for consumers (e.g., a list ofpublications and honorary appointments) A table 340 in FIG. 9 listsexample profiling criteria that can be populated during enrollment in amedical context. The table 340 includes example criteria 342, specificexamples 344 of each criterion 342, and an indication 346 of whetherthat criterion would have an impact on engagement cost.

Providers participating in the brokerage may come from one or morenetworks of service providers. Individual service providers are alsoable to register and enroll with the system. Individual serviceproviders may be independent service providers not affiliated with aprovider network, or service providers affiliated with a providernetwork that is not itself affiliated with the brokerage. This allowsservice providers (or other service provider networks) outside of aselected service provider network to participate in the system.

Provider Introduction

As part of the provider selection process described above, consumersbenefit from access to introductory material from the provider. Asconsumers search for providers to meet their needs, they can select toview only providers where such material is available, producing anincentive for providers to take advantage of such capability. Theexample page 330 in FIG. 8 allows a provider to upload such information.Introductory material may include the provider's picture 332, a textwelcome 334, a welcome recording 336, a video introduction 338, or alink (not shown) to the provider's home page in a clinic or hospital.The introductory material may also include an Internet link (not shown)provided by the brokerage that shows the provider's credentialing on arecognized public site (e.g. The American Medical Association).

Provider Certification

In some examples, the system certifies service providers (or networks ofservice providers) to enroll and participate in the system. This may usecertification standards established by outside agencies, such as the AMAor ABA. A provider wishing to become enrolled in the system registerswith the system and provides his credentials, such as boardcertifications, years in practice, employment history, residencies, andeducation. The system confirms this information and evaluates theprovider as a potential provider in the system. In addition, the systemmay also contact existing providers in the system, such as those withthe same specialty or board certification or who have worked with orattended school with the candidate provider, and ask them to provide apeer review rating of the candidate provider. In some examples, thecertification process is provided by a third party organization or bythe same organization that provides the system for connecting serviceproviders and consumers.

In some examples, the certification process considers load balancing ofavailable or participating service providers in order to encourageservice providers of specialties that have low average availability orare in high demand with respect to the consumer marketplace to enrolland participate in the brokerage. The brokerage may also limit theenrollment of service providers in specialties that have high averageavailability or are in relatively low demand to service providers withcredentials that meet or exceed the credentials of service providersalready participating in the system. The system maintains informationabout the specific needs of the consumers and the availability ofservice providers specializing in areas that can meet the needs of theconsumers. Using this information, the system identifies which areas ofspecialization would benefit from additional service providers and whichareas are underutilized and possibly in need of reducing the number ofservice providers or adding additional consumers. Because the system canconnect service providers and consumers who are separated by greatdistances and who may not normally interact in person, the system allowsservice providers who are underutilized in their current location tomake up for a shortage in another location.

Provider Ratings

To further improve the ability of consumers to choose appropriateservice providers, the brokerage includes a utility for rating theproducts and services provided by the service providers or by a serviceprovider network. The consumers provide feedback (positive and negative)to the system about the products and services provided by a particularservice provider. For example, in a healthcare system, the patients canprovide an evaluation of the quality of treatment or bedside mannerprovided by a physician. In addition, the service providers providefeedback and evaluations of the products and services provided by otherservice providers. For example, a primary care physician can provide anevaluation of the products and services provided by a specialist towhich he referred one of his patients.

In some examples, this information is used to reconsider thecertification of service providers participating in the system.Periodically, the system perform a re-evaluation process on each of theservice providers participating in the system and eliminates or locksout service providers that do not meet certain criteria or a minimumlevel of performance with respect to consumer and peer evaluations.Newer service providers are enrolled to participate in the system for aprobationary period where they are allowed to continue only if theevaluations of their products and services are satisfactory or are abovea predefined threshold for performance.

As part of the provider profile (and as a way for consumers to limittheir search), the system continuously updates each provider's profilewith metrics reflecting the quality of his or her interaction withconsumers. The metrics are updated at the conclusion of every engagementto allow providers immediate feedback as to their level of service. Insome examples, all searches for providers on the system are sorted byprovider rating by default, promoting higher-quality providers. Exampleparameters to be updated and taken into account in setting the ratinginclude consumers' overall ranking of the provider's engagement quality,the number of engagements made by this provider in the last 30 days oroverall, the number of returning engagements as a fraction of allengagements for that provider, the number of redirected engagements fromthis provider to another, and the average turnaround time for messagingwhile not “out-of-office.” In addition to the ratings each provider onthe system has a Provider Statistic Manifest stating operationalstatistics that may interest consumers, such as that provider'savailability for phone conferences over the last 30 days.

Consumers are asked to rank a provider at the end of the engagement aspart of the process of disconnecting. To encourage consumers to providesuch feedback, charges for the engagement continue to accrue until theconsumer completes the ranking. Such a process helps encourage providerengagements to end with a ranking entry, promoting a higher quality ofservice to the brokerage's consumers.

The Provider Console

Providers interact with consumers through a provider console web page350, shown in FIG. 10. This interface is similar to that used by theconsumers. The provider console provides access to the various toolsused by providers. A window shows a live image 352 of the consumer, withtools 354 a, 354 b to control or disable the video feed. A phone control356 allows the provider to initiate a phone call with the consumer. Alog of an ongoing chat 358 is displayed above an input 360 for theprovider's next comment. Other tools are available in tabs 362 on theside, such as accesses to the terms of operation and the legal policiesof the brokerage, such as disclaimers. State setting allows theproviders to change his availability state between states such asoff-line, on-line and out-of-office. Scheduling allows providers toupdate their availability calendar with future times they expect to beavailable on the system, which can in turn result in consumers seeing a“scheduled” state for such providers.

Messaging tools allow providers correspond with consumers inmessage-based engagements. The console also allows the provider toparticipate in chat engagements where the consumer and the providercommunicate back-and-forth in real-time by typing, such as the chat 358in FIG. 10. The brokerage allows a single provider to engage in morethan one chat at a time to maximize his yield while consumers are typingtheir entries. The chat feature also allows the provider to forwardspecific lists of questions to further reduce the need for his time inacquiring information from the consumer at the beginning of anengagement. Tools available to assist the provider in chat or messagingmay include a thread viewer, a clinical summary of the consumer, theconsumer's engagement history, a communication timeline chart, and alibrary of built-in and self-produced message templates for quickresponse. Such templates may also include references, links, andembedded graphical educational content on prevalent topics. In someexamples, the brokerage scans outbound messages for inappropriatelanguage based on the sponsor's preferences.

The console allows the provider to hold a voice conference engagementwith the consumer when the consumer is using either her computer or atelephone. The provider can use the console to redirect his end of theconference to a phone, for example, if bandwidth or other considerationsindicate it or simply based on personal preference. The console alsoallows the provider to engage in video conferences with consumers. Audiomay be served via the console or be may redirected to a telephone. Toverify a provider's identity when using the telephone for a voiceengagement, the system provides the provider with a PIN number throughthe provider console. When the provider calls into the system, oranswers the phone when called by the system, the provider enters the PINto confirm that the person on the phone is the same person who is loggedinto the console. This method is also used to leave secure voicemessage. When a provider wants to leave a message for a consumer, theprovider tells the console and receives a PIN. The provider thenreceives a call from the system, enters the PIN, and leaves a message.The message is then delivered to the consumer with assurances that itwas left by the provider.

At any time during an engagement, the provider may add notes to eitherthe consumer engagement audit (consumer record) or to his own audit ofthe engagement. The audit trail allows the provider to review a completeaudit of his consumer interactions via the console. This audit mayinclude the content and timing of past engagements and related creditsthat the provider is due for the engagements.

In versions of the brokerage for fields, such as health care, that relyon detailed coding of work performed or analyses made, an encoderfeature is provided throughout the engagement. The encoder allows theprovider to add clinical codes describing the findings of theengagement. The codes can be used to further characterize the consumeras well as the basis for outbound communication to the follow-on pointsof care or interfaced clinical systems. The encoder can support, forexample, coverage for disease, drug and procedure classifications.

The system may allow provider to provider interaction either in thecontext of a consumer (e.g., consultation or referral) or without aconsumer context (e.g., provider forums, discussion boards, etc.). In ahealth care context, depending on the license of the provider toprescribe medications to an engaged consumer, the console allows theprovider to use electronic prescription and refill services. Assuming itis authorized, the provider may instruct the system to forwardtranscripts of engagements or other information to another recipientoutside the brokerage. Such exporting may include various modes ofcommunication, such as electronic (e.g., fax, e-mail, SMS) ornon-electronic (e.g., print, mail).

The provider is able to review his account status, system settings, andpreferences. The provider can also access his profile and usersatisfaction and statistics as they are available to consumers. Theconsole also connects to financial services associated with theprovider's participation in the brokerage. This includes status ofcharges, submission of plan claims (e.g., for CPT code 0074T for eVisitsin a health care setting) and claim processing status. In some examples,depending on the mode of deployment of the brokerage from the healthplan standpoint, real-time claim information may be available.

The brokerage offers providers the ability to redirect messages orrequests for appointment to SMS-compatible cellular phones. In thismode, the provider associates a cell phone number with his account andestablishes the type of information that the system can send to themobile device. Such information may include engagement-relatednotifications as well as system-related notifications (e.g., anannouncement about a high-traffic state asking providers to makethemselves available and offering a higher fee to do so).

Open Access Forum

In some examples, the system includes an open forum that supportsfreeform engagements on different topics between all constituents. Theopen forum allows a consumer to anonymously post any of the issuesidentified by the consumer advisor or to manually post questions into apublicly-accessible forum. While the consumer posts his issuesanonymously, responses or threads developing as other users provideanswers or discuss the issues are forwarded to the consumer that postedthe original issue. In some examples, the system monitors the identityof those who respond to a posting and differentially informs theconsumer if a user known to be a provider posts a response. In someexamples, the brokerage pays providers to post responses to entries theythink are significant on the open forum. Unlike consumer entries,provider entries are identified and allow a consumer to startengagements with providers whose answers he finds informative orbeneficial. The open forum also serves as a vehicle for providers topublicize themselves to consumers.

In some examples, a consumer posts the audit of one or more engagementsonto the open forum for the benefit of other consumers. The brokeragestrips any data that identifies the participants (i.e., it annonymizesthe data) and offers the consumer the ability to review the anonymizeddata prior to posting it.

Sample Use Cases in the Medical Field

Generally Well Consumer

In one example, a consumer logs on to the system to explore a benefitthat was promoted to him by his employer. The consumer is advised thatuse of the platform to increase her understanding of managing her healthcan be rewarded through an incentive program offered by theemployer-provided health plan. The consumer advisor engages the consumerand undertakes a “no-reported-problem” assessment. At the end of theassessment, the consumer is surprised to find several areas where shecan benefit from engagements. In this example, these areas includemissing key cancer screening tests, improper gynecological follow-up,unattended family risk factors and a collection of lifestyle issues thatboth impose increasing risks and noticeably increase her stress andsleep quality issue levels. The brokerage lists and sequentiallyconnects the consumer to an Ob/Gyn provider and a nurse coach, eachalready knowledgeable about the respective gaps identified. A summaryreport with a detailed appointment request is forwarded to theconsumer's registered primary care physician to schedule the tests andreferrals. The consumer receives educational material on the specifictests and risk factors that were identified.

Parents of a Newborn

In another example two parents are concerned with a rash developing ontheir child's left buttock. The parents are connected to a pediatricnurse who walks them through the characterization of the rash anddetermines it is a diaper-rash that can be managed by simplemoisturizing ointment. The parents are advised that such a rashtypically subsides in 2-3 days without treatment. In this example, theparents opt for further reassurance via pediatrician counseling. Aconnected pediatrician provides confirmation of the nurse's diagnosisand advise after reviewing the online notes. The parents follow-up withtheir regular pediatrician the following week, after the documentationof the event has been faxed to the pediatrician office.

A Chronic Diabetic Patient with Mobility Restrictions

In another example, a patient is a chronic overweight diabetic that ishome bound. The patient develops pain in his shin above the ankle andengages the brokerage which directs him to an internal medicinespecialist. The patient chooses to engage over the phone and connectedwith the specialist through the brokerage switchboard. The specialistquestions the patient to identify a possible location of a developingleg ulcer and directs the patient to exercise extreme hygiene and heatedcompresses in the affected area. The specialist advises the patient notto wait for the pain to possibly subside. The patient's provider and hishealth plan's care manager are notified of the engagement and next-dayadmission for investigation and debridement is scheduled. The earlystage ulcer identified by the specialist during the telephone engagementis managed, thus preventing a life-threatening deterioration of thepatient's condition.

A 46 Year Old Banking Executive Female

In another example, a consumer logs on and takes the health riskassessment. The system recognizes that the consumer has questions aboutcertain cosmetic procedures. The system formulates the questions thatshould be addressed and offers to connect the consumer with a plasticsurgery resident. The consumer receives a list of the names and natureof the procedures she may want to explore for her cosmetic concerns.Links to reference information on each procedure are added to herrecord. Links that assist the consumer in comparing costs and possibleproviders in her geographical area who perform the procedures are alsoadded.

Utilization Management

In some examples, the brokerage system 100 includes software orfunctionality for reducing or preventing over-utilization of thebrokerage system 100. In some situations, in comparison to scheduling anin-person doctor visit and traveling to a doctor's office for theappointment, the system 100 decreases the time and hassle for theconsumer to receive medical information because the consumer simply goesto a website and requests to engage with a provider. This engagementoccurs in real time over the Internet. One of the concerns associatedwith offering such easy access to a provider, is that it can result inover consumption of services.

The brokerage system 100 reduces or prevents over-utilization bymodifying the amount a consumer pays for the services. For example, atone extreme, if all costs of the brokerage system 100 were covered by athird party such as an insurance company, the consumer might use thesystem very frequently because the system would appear to be “free” tothe consumer resulting in over utilization. At the other extreme, if allcosts of the brokerage system 100 were paid by the consumer, theconsumer might be less likely to engage with a provider using thebrokerage system because of the cost resulting in under utilization.When the system 100 is under utilized, the consumers may be more likelyschedule in-person visits with a doctor (which insurance covers orsubsidizes) regarding their medical questions or concerns and/or notseek medical care potentially resulting in advancement of the conditionboth potentially resulting in increased fees to the third party. Assuch, insurance companies have competing interests of encouraging use ofthe brokerage system 100 while limiting over utilization.

Provider Pricing

In some examples, the brokerage system 100 allows providers to set theirown price, and allows consumers to select a provider on the basis of theprovider's price. Allowing the providers to set their own price canreduce over-utilization by making the consumer aware of the cost and byencouraging the consumer to engage with a provider that is lessexpensive. For example, the portion of the price covered by a thirdparty can vary based on the price set by the provider and/or theexperience level of the provider. The price presented to the consumerand/or paid by the consumer may be influenced by the insurance availableto the consumer and what insurance plans the provider participates in(e.g., as described below).

FIG. 11 shows a flow chart of a computer implemented process 360 forallowing providers to set their own prices. The brokerage system 100receives 362 prices from multiple service providers. The prices willlikely differ between different providers. The provider can submit anyprice and, if the consumer selects to engage with the provider, theprovider receives that price (or an amount related to that price) ascompensation after completion of the engagement. The brokerage system100 searches 364 for providers based on a request from a consumer (e.g.,as described above) and sorts 366 the resulting list of providersmeeting the consumer's criteria based one or more factors. For example,the system can sort the list of providers based on how closely aprovider matches the desired criteria such as location, specialty,education and/or the system can sort the providers based on the price tothe consumer (e.g., lowest to highest). The brokerage system 100displays 368 the list of providers including an indication of the priceassociated with each provider to the consumer.

FIGS. 12A and 12B show an exemplary user interfaces 370 and 380 thatinclude a list of providers 379 displayed in response to a consumer'ssearch for a provider. In addition to displaying the name of theprovider, the list of providers 379 includes an availability indication371, a cost 372 to engage with the provider, and a provider rating 374.A consumer views the biographies of providers included in the list ofproviders 379 by selecting a particular provider from the list ofproviders 379. For example, in FIG. 12A the consumer has selectedprovider 382 a and the biography of John Jefferson is displayed in aportion 377 of the user interface 370 and in FIG. 12B the consumer hasselected provider 382 b and the biography of Mark Erichman is displayedin portion 377 of the user interface 380. The provider biographies alsoinclude an indication 378 of a cost to engage with the particularprovider and an indication 376 of the provider rating for the provider.

In some examples, the price associated with a particular providerdisplayed on the user interface 370 and 380 is a total price for theengagement. For example, the price can be the sum of the compensationpaid to the provider and the amount received by the brokerage system 100for providing the service. This total price is displayed to the consumerto allow the consumer to make an informed decision when selecting aprovider. For example if a consumer has a broken hand, the consumer seesthe total cost and makes an informed decision regarding whether toengage with a top orthopedic surgeon that specializes in injuries of thehand or with another provider based on their injury and the relativecost.

In some additional examples, the price associated with a particularprovider displayed on the user interface 370 and 380 is an out-of-pocketexpense amount to be paid by the consumer. For example, the price can bethe sum of the compensation paid to the provider and the amount receivedby the brokerage system 100 for providing the service minus the portionof the total cost covered by insurance or other subsidies. Thisout-of-pocket expense amount is displayed to the consumer to allow theconsumer to balance the cost versus the perceived utility of engagingwith a particular provider. For example, if two providers have similarqualifications and one is covered by the consumer's health insurance andthe other is not, the consumer determines which provider to engage withbased, at least in part, on the expense the consumer would be requiredto pay.

Consumer Fee Allocation

In some embodiments, the system 100 reduces or prevents over-utilizationby adjusting a fee charged to a consumer based on information related topast engagements of the consumer, medical history of the consumer,insurance of the consumer, and/or other information associated with theconsumer or provider.

FIG. 13 shows a flow chart of a computer implemented process 390 fordetermining a portion of the cost to be paid by the consumer. Thebrokerage system 100 receives 392 a request from a consumer to engagewith a provider and determines 394 a total cost for the engagement. Forexample, the total price can be the sum of the compensation paid to theprovider and the amount received by those who operate and manage thebrokerage system 100 for providing the service. The computer systemaccesses information related to the consumer and/or the engagement suchas medical status information about the consumer 398, insuranceinformation for the consumer 400, and/or information about previousengagements of the consumer 402. Based in part on the informationreceived, the system 100 determines 396 a portion of the total cost tobe paid by the consumer. This portion of cost can then be presented tothe consumer and the consumer can decide whether to engage with theprovider given the cost.

The portion of the cost paid by the consumer versus the portion paid bya third party (e.g., an insurance carrier) can vary over time. Bymodifying the portion of the total cost paid by the consumer, the system100 can prevent over utilization by an individual. In addition, if theportion of the cost paid by the consumer increases as the number ofengagements for the individual increases (and therefore the portion ofthe cost paid by the third party decreases), the financial exposure ofthe third party can be reduced.

In some embodiments, the total amount covered by an insurance carrier oranother third party can be capped in order to limit the potentialfinancial exposure of the insurance carrier or third party. Theinsurance carrier or third party can cap their exposure by setting amaximum number of engagements that will be covered (or for which thecarrier will make a partial reimbursement) or setting a maximum dollaramount that they will pay for engagements using the brokerage system100.

FIG. 14 shows a flow chart of a computer implemented process 410 fordetermining a portion of the cost to be paid by the consumer. Thebrokerage system 100 receives 412 a request from a consumer to engagewith a provider and determines 414 a total expenditure (e.g., a totalnumber of past engagements during a time period, a total dollarexpenditure during a time period) by the insurance carrier or thirdparty for the consumer. The system 100 compares 416 the totalexpenditure for the consumer to a maximum expenditure set by theinsurance carrier or third party to determine 418 if the consumer hasexceeded a threshold or maximum expenditure. If the consumer hasexceeded the threshold or maximum expenditure, the system 100 requires420 the consumer to pay the entire cost for the engagement. As such, thetotal financial exposure of the insurance carrier or third party iscapped. On the other hand, in the consumer has not exceeded thethreshold or maximum expenditure, the system determines 422 a portion ofthe total cost (if any) to be paid by the consumer. As described above,the portion of the total cost paid by the consumer can vary based onfactors related to the consumer's utilization of the brokerage systemand/or other information related to the consumer. If the consumerengages with the provider, the system 100 updates 424 the totalexpenditure for the consumer to reflect the engagement. The updatedtotal expenditure amount can subsequently be used in the calculation ofthe fee charged to the consumer for a future engagement.

For example, the insurance carrier or third party may cover apredetermined number of engagements (e.g., 5 engagements, 10engagements, 20 engagements) by the consumer per month/quarter/year(regardless of the total cost of each engagement) with a co-payment(e.g., $5.00-$20.00) charged to the consumer. Until the consumer reachesthe predetermined number of engagements the consumer is responsible onlyfor the co-payment (if any) set by the predetermined number ofengagements. However if the consumer engages with the system in excessof the predetermined number of engagements, the consumer still has fullaccess to the brokerage system 100 but will be required to cover theentire cost of their engagements themselves (e.g., without a co-paymentby the insurance carrier or third party).

In another example, the insurance carrier or third party may cover apredetermined dollar amount (e.g., $100.00, $200.00, $500.00) for theconsumer per month/quarter/year. Until the consumer reaches thepredetermined amount the consumer is responsible only for payment of theco-payment (if any). However, if the consumer engages with the system inexcess of the predetermined amount covered by the insurance carrier orthird party, the consumer can still have full access to the brokeragesystem 100 but will be required to cover the entire cost of theirengagements themselves (e.g., without a co-payment by the insurancecarrier or third party).

FIG. 15 shows an exemplary user interface 430 that allows the brokeragesystem 100 to establish rules used to determine a co-payment to be paidby a consumer for an engagement. As shown in column 432 of the userinterface 430, in this example, the co-payment is based in part onwhether the consumer has any chronic conditions (e.g., ongoingconditions that may require frequent or ongoing medical attention suchas arthritis, high blood pressure, asthma, cancer, HIV, etc.). Inaddition, as shown in column 434, the co-payment is based on the numberof annual engagements of the consumer with the brokerage system 100. Ingeneral, the co-payment for a consumer with a chronic condition is lessthan the co-payment for a consumer without any chronic conditions. Thisencourages those consumers with chronic conditions to actively managetheir condition and seek help when they have questions related to thecondition. In addition, the co-payment (both for consumers with andwithout chronic conditions) increases with the number of engagements ofthe consumer. For example, for a consumer without any chronicconditions, the co-payment for their first 10 engagements is 10% of thetotal cost (e.g., as shown in row 438), the co-payment for theirengagements 30-50 is 50% of the total cost (e.g., as shown in row 440),and the co-payment for any engagements over 50 is 100% of the total cost(e.g., as shown in row 442). The sliding scale of the co-payment andincreasing cost to the consumer helps to prevent over utilization of thebrokerage system 100.

Embodiments can be implemented in digital electronic circuitry, or incomputer hardware, firmware, software, or in combinations thereof.Apparatus of the invention can be implemented in a computer programproduct tangibly embodied or stored in a machine-readable storage devicefor execution by a programmable processor; and method actions can beperformed by a programmable processor executing a program ofinstructions to perform functions of the invention by operating on inputdata and generating output. The invention can be implementedadvantageously in one or more computer programs that are executable on aprogrammable system including at least one programmable processorcoupled to receive data and instructions from, and to transmit data andinstructions to, a data storage system, at least one input device, andat least one output device. Each computer program can be implemented ina high-level procedural or object oriented programming language, or inassembly or machine language if desired; and in any case, the languagecan be a compiled or interpreted language.

Suitable processors include, by way of example, both general and specialpurpose microprocessors. Generally, a processor will receiveinstructions and data from a read-only memory and/or a random accessmemory. Generally, a computer will include one or more mass storagedevices for storing data files; such devices include magnetic disks,such as internal hard disks and removable disks; magneto-optical disks;and optical disks. Storage devices suitable for tangibly embodyingcomputer program instructions and data include all forms of non-volatilememory, including by way of example semiconductor memory devices, suchas EPROM, EEPROM, and flash memory devices; magnetic disks such asinternal hard disks and removable disks; magneto-optical disks; andCDROM disks. Any of the foregoing can be supplemented by, orincorporated in, ASICs (application-specific integrated circuits).

Other embodiments are within the scope and spirit of the descriptionclaims. For example, due to the nature of software, functions describedabove can be implemented using software, hardware, firmware, hardwiring,or combinations of any of these. Features implementing functions mayalso be physically located at various positions, including beingdistributed such that portions of functions are implemented at differentphysical locations.

1. A computer-implemented method, comprising: receiving a request from aconsumer of medical services to engage with a provider of medicalservices in real time over the Internet using a computer-based brokeragesystem; accessing stored information related to past engagements of theconsumer using the computer-based brokerage system; and determiningallocation of a fee between the consumer and a third party for anengagement between the consumer and the provider based at least in parton the information related to the past engagements of the consumer. 2.The method of claim 1, wherein the information comprises a total numberof engagements by the consumer during a period of time.
 3. The method ofclaim 1, wherein the information comprises a total financial expenditureof an insurance company during a period of time.
 4. The method of claim1, wherein determining the allocation of the fee between the consumerand a third party comprises determining a percentage of a total cost tobe paid by the consumer.
 5. The method of claim 1, further comprisingaccessing health related information about the consumer.
 6. The methodof claim 1, wherein determining the allocation of the fee between theconsumer and a third party comprises determining the allocation of thefee between the consumer and a third party based at least in part on theinformation related to the past engagements and the health relatedinformation.
 7. The method of claim 1, wherein determining theallocation of the fee between the consumer and a third party comprisesallocating the entire fee to the consumer if an amount paid by the thirdparty is greater than a threshold set by the third party.
 8. The methodof claim 1, wherein the third party comprises an insurance carrier.
 9. Acomputer program product residing on a computer readable medium forproviding broker services to consumers and service providers, thecomputer program product comprising instructions for causing a computerto: receive a request from a consumer of medical services to engage witha provider of medical services in real time over the Internet using acomputer-based brokerage system; access stored information related topast engagements of the consumer using the computer-based brokeragesystem; and determine an allocation of a fee between the consumer and athird party for an engagement between the consumer and the providerbased at least in part on the information related to the pastengagements of the consumer.
 10. An apparatus comprising: a processor;and a computer program product residing on a computer readable mediumfor providing broker services to consumers and service providers, thecomputer program product comprising instructions for causing theprocessor to: access stored information related to past engagements ofthe consumer using the computer-based brokerage system; and determine anallocation of a fee between the consumer and a third party for anengagement between the consumer and the provider based at least in parton the information related to the past engagements of the consumer.